IPPF-Abortion Legislation in Europe 2009 - SPDC

88 Pages·2009·0.4 MB·English

ABORTION LEGISLATION
IN EUROPE

(UPDATED January 2009)

IPPF EUROPEAN NETWORK
Rue Royale 146
1000 Brussels
Belgium
Email: [email protected]
Countries

AUSTRIA.........................................................................................................................................................................................8
BOSNIA and HERZEGOVINA..............................................................................................................................................12
BULGARIA....................................................................................................................................................................................14
CYPRUS..........................................................................................................................................................................................16
CZECH REPUBLIC.....................................................................................................................................................................18
DENMARK.....................................................................................................................................................................................20
FINLAND.......................................................................................................................................................................................26
FRANCE..........................................................................................................................................................................................28
GEORGIA.......................................................................................................................................................................................30
GERMANY.....................................................................................................................................................................................32
GREECE..........................................................................................................................................................................................34
HUNGARY.....................................................................................................................................................................................35
ICELAND........................................................................................................................................................................................37
IRELAND.......................................................................................................................................................................................39
ISRAEL...........................................................................................................................................................................................41
ITALY..............................................................................................................................................................................................43
KAZAKHKSTAN..........................................................................................................................................................................45
KYRGYZSTAN..............................................................................................................................................................................47
LATVIA...........................................................................................................................................................................................49
LITHUANIA..................................................................................................................................................................................51
LUXEMBOURG............................................................................................................................................................................53
MACEDONIA (FYR)..................................................................................................................................................................55
MOLDOVA.....................................................................................................................................................................................58
NORWAY.......................................................................................................................................................................................61
POLAND.........................................................................................................................................................................................63
PORTUGAL...................................................................................................................................................................................65
ROMANIA......................................................................................................................................................................................67
RUSSIAN FEDERATION.........................................................................................................................................................69
SLOVAK REPUBLIC..................................................................................................................................................................71
SPAIN.............................................................................................................................................................................................73
SWEDEN........................................................................................................................................................................................76
SWITZERLAND...........................................................................................................................................................................78
TAJIKISTAN................................................................................................................................................................................80
TURKEY..........................................................................................................................................................................................82
UNITED KINGDOM...................................................................................................................................................................84
UZBEKISTAN...............................................................................................................................................................................86

GLOSSARY OF TERMS............................................................................................................................................................88

January 2009 2
Notes

1) The document is in its eighth edition. The previous one was compiled in February 2004. It has been
updated following information received from IPPF European Network Member Associations (MAs)

2) In DISPARITY IN THE APPLICATION OF THE LAW, and in COMMENTS the text is directly from
the Member Associations (MAs).

3) The exchange rate for the conversion into US$ was calculated at the time of the revision.

Acknowledgements

IPPF European Network would like to thank all its Member Associations for their invaluable contributions
to this update.

January 2009 3
ALBANIA
Albanian Center for Population and Development
[email protected]

LEGISLATION

Abortion Law Nr 8045, 7 December 1995, “on the interruption of pregnancy”

GROUNDS/GESTATIONAL LIMITS

Up to 12 weeks:
 On request, in case a woman considers that a pregnancy causes psychological and social problems

Up to 22 weeks:
 For social reasons
 Rape or other sexual crime

No Limit:
 Severe (incurable) malformation of the fetus
 If continuing the pregnancy and/or childbirth would put the woman’s life or health at risk

REGULATIONS/CONDITIONS

Abortion should be performed by a physician-specialist/obstetrician-gynaecologist, and can take place
in public and private health institutions.

Pre- and post-abortion counselling is obliged. The physician performing the abortion is obliged to
inform women of family planning services and to advise them about contraceptive methods.

In case a woman, after the pre-abortion counselling, repeals the request, she is asked by the physician
to confirm her request in writing. This confirmation should be done at least 7 days after her first
request. If the time span of 7 days surpasses the legal limits, the physician may decide to reduce it to
2 days.

Unmarried minors up to 16 need the consent of the person exercising parental authority or legal
protection. The request for an abortion should not be made in their presence.

A health commission consisting of three physicians decides, after examination and consultation, to
allow for an abortion on medical grounds (thus no limit as mentioned above).

An abortion for social reasons (up to 22nd week) needs the approval of a commission of three
specialists (physician, social worker and lawyer).

January 2009 4
METHODS

Types of abortion methods available in country are:
 Vacuum aspiration (electric or manual)
 Dilatation and Curettage
 Induction with Misoprostol (PG analogues)
 Sextio caesarean minor

Medical abortion was introduced in Albania through a pilot project implemented in the Tirana Maternity
Hospitals. Although many Ob/Gyns use RU486 to provide medical abortion, it is not legalized. In the
Albanian Approved List of Drugs, RU486 is not included. Actually there is no amendment or law
approved on medical abortion.

COST

A total of lek 3.600 (US$ 40) for the abortion fee plus laboratory tests (incl. Ultrasound).

In private clinics this sum is double.

DISPARITY IN THE APPLICATION OF THE LAW:

 Although required by law, routine analyses are not regularly done before the abortion procedure.
 The reflection period (7 days – by law) is not respected, mostly because women are not informed
about their rights. Neither the social worker nor health practitioners inform women on this.
 Women pay “under the table” and give bribes to the doctors who perform the abortion.
 Obligatory pre- and post-abortion counselling is not always respected.
 Most abortions performed in private clinics are not reported and there are no standard reporting
forms.
 There is no appropriate supervision plan in place for both private and public clinics. The clinics
supervision is not done on a regular basis.
 Almost half of private clinics do not comply with legal requirements regarding the needed surface
and equipment.
 Women do not necessarily present an identification document at the clinic.

COMMENTS:

 The 1995 law overturned the previous one whereby abortion was legally permitted only on limited
grounds
 Abortion is not performed in the MA’s clinics

January 2009 5
ARMENIA
Armenian Association ‘For Family and Health’
[email protected]
www.armfha.com

LEGISLATION

Abortion is permitted since 1955

GROUNDS/GESTATIONAL LIMITS

Up to 12 weeks:
 On request

Up to 22 weeks:
 Social grounds (if husband died during woman’s pregnancy; if woman was deprived of maternal rights
during pregnancy; divorce; rape)
 Medical grounds (such as tuberculosis, syphilis, HIV/AIDS, a malignant tumour, mental disorder or
chronic alcoholism; underdeveloped reproductive system of teenager under-16)
 Family risk or diagnosed foetal malformation

REGULATIONS/CONDITIONS

 Menstrual regulation (called mini-abortion in Armenia) is permitted up to 7 weeks of pregnancy.
 Women under age of 18 should obtain consent from parents or a lawful proxy or, if this is impossible,
from a relevant medical commission.
 According to the MoH standards, abortion should be performed only by a licensed obstetrician
gynaecologist and only in hospital conditions such as maternity homes and obstetrics/gynaecological
departments in the hospitals or clinics with at least 15 beds and relevant license. MoH permits medical
abortions to be performed in the licensed out-patient medical facilities (so called Female’s
Consultancies).
 Although registration of the abortion is mandatory, it is not always done.
 In order to ensure the quality of abortion services, the Government has issued regulations on abortion
procedures, which include a 4 hours period of stay after the intervention and family planning
counselling after the abortion. However, these regulations are not followed by the medical
practitioners and not controlled by the MoH.

METHODS

Although medical abortion is legalized, Armenia is still in the process of running trials and registering the
necessary drugs. Mifepristone is not registered; Misoprostol is registered as a drug used to treat ulcers,
but has not been registered as drug that can be used for medical abortion.

Medical abortion can be performed out of the hospital in the licensed Female’s Consultations. However,
many women self-induce abortion at home using Misoprostol (brand name is Cytotec) based on the
physician’s advice or experience of other women. Cytotec is generally used to treat ulcers and can be
obtained in the pharmacies without prescription. One tablet of Cytotec costs around US$5-10.

Most used methods:
Surgical abortion via dilatation and curettage and electrical vacuum aspiration are the most commonly
used method of pregnancy termination.
January 2009 6
COST

The cost of a surgical abortion up to 12 weeks of gestation varies from clinic to clinic, between US$ 30
and US$ 50 per procedure. All state clinics providing abortion services charge an official fee of $30,
which almost equals the minimum wage.

There are also additional unofficial, illegal payments, which range from US$ 20 to US$ 500, depending
on the gestational limit. The cost of an abortion is higher, if it is performed with anaesthesia, or if it is
illegal. Both legal and illegal costs have considerably increased in the last 10 years.

The cost of an illegal abortion significantly exceeds an average monthly salary. A social security system
in Armenia does not exist yet. Although there is a state program to provide services for free to poor
people, most of the poor can’t access the program due to complex criteria and bureaucratic procedures.

DISPARITY IN THE APPLICATION OF THE LAW:

 Abortion services are not available in rural areas or in some urban settings
 The poor and young unmarried women often perform self-induced abortion with a high risk of life
threatening complications and consequences.

COMMENTS:

 Regardless of the permissive legislation for the abortion and availability of national regulations on
abortion services, there are several problems related to abortion services in the country. They include
lack of access to abortion services for poor and young women, a poor quality of the abortion care
provided and a lack of post-abortion contraception.
 The quality of abortion services provided in health facilities is poor. Although the quality of abortion
care has never been assessed at the national level, the MoH is aware of the fact that abortion services
are not of high quality and needs a lot of improvement and introduction of new technologies.
 Presently, the most commonly used abortion technique is dilatation and curettage. Manual vacuum
aspiration is being used sporadically and only in private clinics in Yerevan. Mifepristone and
Misoprostol are not registered in the country to perform medical abortion.
 An indicator demonstrating quality of abortion services is the level of post-abortion complications that
contribute to women’s disability and death cases. As the NRHS (1998) showed complications after
abortion were experienced by 16% of the interviewed women. The quality of abortion is also
compromised by a lack of post-abortion counselling provided by service providers. The study showed
that in 60% of cases, no family planning counselling after abortion was provided, and 75% of women
complained about pain beyond comfort level during last abortion (NRHS, 1998).
 Access to safe abortion is an issue for low-income and young people who cannot afford to pay for
services or don’t have access to information about available services. Especially young unmarried
women are at risk of unsafe abortion due to social prejudice against premarital sexual relations.
Parents are not capable to provide support and help to their children that are faced with an unwanted
pregnancy. The causes lie in a traditional attitude of people to avoid talks on sexual topics between
young and older generations. Even when parents are willing to help, very often they lack skills to
discuss sexuality issues with their children.
 As a result of compromised access to abortion services there are cases of unsafe self-induced
abortion. According to the National reproductive Health Survey (1998), at least 23.4% out of all
reported miscarriages were due to self-induced abortion. Official statistics do not provide accurate and
reliable data on rate of unsafe abortion in the country.

January 2009 7
AUSTRIA
Österreichische Gesellschaft für Familienplanung (ÖGF)
[email protected]
www.oegf.at

LEGISLATION

Federal Law 23 January 1974, effective in January 1975 (Bundesgesetzblatt, No. 60, 1974)

GROUNDS/GESTATIONAL LIMITS

Up to three months from completed implantation:
 On request

Second trimester:
 Serious risk to physical health of women (that cannot be averted by other means)
 Risk to mental health of women (that cannot be averted by other means)
 Immediate risk to life of woman (that cannot be averted by other means)
 Serious foetal impairment (physical or mental)
 Woman is a minor (under 14 years)

REGULATIONS/CONDITIONS

 Abortion must be performed by a physician after a previous medical consultation
 No physician is obliged to perform an abortion or to take part in it, except where it is necessary
without delay to save the life of the pregnant woman from an immediately threatening danger
which cannot otherwise be averted.
 In public hospitals following examinations and tests are required: rhesus factor, ultrasound, HIV,
lues, hepatitis

METHODS

Vacuum Aspiration is the most commonly used method. Medical abortion (Mifegyne) is not very
common.

The regulation for Mifegyne allows the use of the drug only in hospital and clinics, therefore medical
abortion can be performed only in hospitals. There are three private clinics specialised in abortion in
Vienna. They also offer medical abortion. In three provinces there are no public hospitals which
provide abortions. In all provinces (except one) there are private clinics.

COST

Induced abortion is covered by the (normal) health insurance

 State hospitals: € 300 – 840(US$ 459-1285,20)
 Private abortion clinics: € 350-450 (US$ 535,50-688,50)
 Private practitioners: €350-450 (US$ 535,50-688,50)

January 2009 8
DISPARITY IN THE APPLICATION OF THE LAW:

 Due to conscientious objection from both medical personnel and hospital management, abortion
facilities are not readily available all over the country.
 According to the law, abortion can be performed up to 3 months after completed implantation, but
in practice they are performed up to 12 weeks after Last Menstrual Period even though there is no
legal basis for this.
 According to the law, abortion can be performed by general practitioners and gynaecologists. But
the regulation for Mifegyne allows the use of the drug only in hospital and clinics, therefore medical
abortion can be performed only in hospitals. There are three private clinics specialised in abortion in
Vienna. They also offer medical abortion. In three provinces there are no public hospitals which
provide abortions. In all provinces (except one) there are private clinics.
 Abortion tourism takes place from West to East Austria. Between 100 and 200 women per year are
still going to the Netherlands to get a late second trimester abortion. After the 18th week it is hardly
possible to get an abortion in Austria.
COMMENTS:

 It is believed that illegal abortion is not practised on any scale. Statistics are not available though.
 Public information on the availability of abortion services is very scarce.
 In a public hospital, the abortion will be registered, in a private clinic not
 Very few public hospitals are offering abortion at a reasonable price (app. 5 hospitals are offering
abortion for less than € 350). It is difficult for women to get an abortion especially outside Vienna
and outside other big cities
 Very few doctors perform abortions in private practice in rural areas

January 2009 9
BELGIUM

Sensoa Fédération Laïque de Centres de Planning Familial
(FLCPF)
[email protected] [email protected]
www.sensoa.be www.planningfamilial.net

LEGISLATION

Law on termination of pregnancy 3 April 1990
National Evaluation Committee (Law of 13 August 1990)

GROUNDS/GESTATIONAL LIMITS

Abortion remains forbidden (art. 348, 350, 351, 352 of the Penal Code) but legal

Up to 12 weeks after conception (or 14 weeks after Last Menstrual Period):
 If the pregnancy causes a ‘state of distress’ for the woman (– the law does not define the state of
distress).

No limit:
 ‘Serious’ risk to health of woman
 ‘Extremely serious and incurable disease’ of fetus

REGULATIONS/CONDITIONS

 Can only be performed in a hospital/clinic by a doctor
 Consultation with a doctor
 Compulsory waiting period (6 days)
 “Unity of place”: first consultation and the abortion has to take place in the same clinic/hospital
 Compulsory counselling on alternatives to abortion (adoption, keeping the baby)
 Parental consent for minors is not mentioned in the law
 The opinion of a 2nd doctor is requested in case of ‘serious’ risks to health of the woman or if the fetus
is judged to be suffering from an ‘extremely serious or incurable disease’

January 2009 10